Carriers for drips

[MGMR]

I just had a topic I need clarification on.

I work in a peds cardiac ICU where we use "carriers" of a patient's maintenance fluid at rates of mostly 1cc/hr (sometimes 3-5cc/hr for non-neonates or for RA lines). I'm confused as to the purpose of the carriers. First, I thought that the carriers were to "carry" the drips to the patient faster. But if you program a pump to infuse a drip at a certain rate, it will only push the med through the line at that rate, and changing the rate of the carrier fluid would only change the rate of the fluid at the very end of the line near the patient (through the ultrasite white cap, which is an extremely small amount of fluid).

My second answer when researching my question was that the rate of all the fluids together must be at least 1cc/hr to keep the small lines patent, and since neonates' weights are so tiny the fluid infusing over an hour can be very small.

Is this thinking correct about carrier fluids used to keep lines patent mainly?

It's hard to find an answer to this specifically for pediatric/neonates because the answers I found came mostly from adult ICU nurses who use adult tubing, with y-sites etc. With our patients, we mostly use small 1cc med tubing with filters that each attach to its own port, and not the adult tubing with y-sites etc.

Thanks for the help!

[offlabel]

The thinking goes that if you're titrating drip rates frequently, a carrier helps with even delivery of drugs. So if you cut a rate by half of one thing, you won't affect another's delivery that much. Conversely, you won't give a big bolus of something when doubling something else.

Just examples.

[Julius Seizure]

Also, yes, for line patency. Generally the rule of thumb here for central lines is that if the total fluid going through the line is less than 3ml/hr, it needs a heparinized carrier fluid.

(But with heparin you can just infuse 1ml/hr)

[offlabel]

Also, yes, for line patency. Generally the rule of thumb here for central lines is that if the total fluid going through the line is less than 3ml/hr, it needs a heparinized carrier fluid.

(But with heparin you can just infuse 1ml/hr)

Been a whole since I did Peds ICU.... still putting heparin in those lines? Thought they figured out it wasn't necessary?

[meanmaryjean, DNP, RN]

Carriers are indeed for line patency.

[offlabel]

Goes without saying... if there is a line or lumen that is redundant in that crystalloid replacement is being accomplished elsewhere and there are no medications infusing thru it, it can just be capped and flushed.

[NotReady4PrimeTime, RN]

We try NOT to cap and flush atrial lines, arterial lines and central monitoring lines. It's not a great idea to do it with umbilical lines either.

[Julius Seizure]

We try NOT to cap and flush atrial lines, arterial lines and central monitoring lines. It's not a great idea to do it with umbilical lines either.

True, there are some lines that you just dont cap - not worth the risk.

Goes without saying... if there is a line or lumen that is redundant in that crystalloid replacement is being accomplished elsewhere and there are no medications infusing thru it, it can just be capped and flushed.

I am talking about lines that you do have a drip running through. If I have Prostin running at 0.14 ml/hr, that is not going to keep my line patent. We use heparin carriers in our 2 french and 3 french central lines because they do become occluded and they do collect fibrin deposits. Each children's hospital that I have worked at has had a policy similar to this:

Total rate 1-3ml/hr - heparin carrier

3-5 ml/hr - saline carrier may be appropriate

Dextrose in a line running less than 5ml/hr may need heparin.

[BeenThere2012, ASN, RN]

Been a whole since I did Peds ICU.... still putting heparin in those lines? Thought they figured out it wasn't necessary?

My recent experience is not to use heparin for Pedi patients, but a lot of NICUs still do. Depends on the rate and sometimes the type of line and unit protocols.

[BeenThere2012, ASN, RN]

Goes without saying... if there is a line or lumen that is redundant in that crystalloid replacement is being accomplished elsewhere and there are no medications infusing thru it, it can just be capped and flushed.

It's not about crystalloid replacement...Its about a carrier in very low rate/volume infusions. Also, getting lines in Pediatric or NICU patients is.very difficult at times so we don't cap as often as in adults.

[nursemcsleepy, BSN, RN]

We use NS carriers for drips less than 1cc/hr. Heparin/ is only used for CVPs and art lines. It's just for patency.

[edilleyrn]

We never cap off. We always use a heparinized flush bag to keep RA lines patent. We do however cap off and heparin lock PICC lines if aren't using the port for any drips. I was always explained that the carrier fluids were to help "carry" the drips into the patient. I never even stopped to think about how the pump already does that! Good for you for using your critical thinking skills. I will be sure to ask at work what the sole purpose of these carrier fluids are next time I go in. Without drips, I know they are for line patency. With drips, I just expected that it was to help push the drips in equally.